ACLS (Main)

2010 AHA Recommendation Changes

• Routine use of cricoid pressure is NOT recommended
• Airway adjunct is recommended while performing ventilation
• Pulse/rhythm checks should only occur q2min
• Most critical component is high-quality compressions
• Atropine and cardiac pacing are NOT recommended for asystole/PEA

ECG Analysis

1. Is the rhythm fast or slow?
2. Are the QRS complexes wide or narrow?
3. Is the rhythm regular or irregular?

Adult Cardiac Arrest

V-Fib and Pulseless V-Tach

• Shock as quickly as possible and resume CPR immediately after shocking
  • Biphasic - 200J
  • Monophasic - 360 J
• Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
• Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
  • 1st line: Amiodarone 300mg IVP w/ repeat dose of 150mg as indicated
  • 2nd line: Lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
  • Magnesium 2g IV, followed by maintenance infusion
    • Only for polymorphic V-tach

Asystole and PEA

• Give Epi 1mg q3-5min
• Consider H's and T's
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion
  • Hypo/hyperkalemia
  • Hypothermia
  • Tension pneumo
  • Tamponade
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary

See Also

• ACLS (Treatable Conditions)
• Adult Quick Drug Card
• SVT
• Antiarrhythmics
• Arrhythmias (DDX)
• Cardiac Arrest Management
• Synchronized Cardioversion

Source

• AHA 2010 Guidelines for ACLS